Provider Demographics
NPI:1174234496
Name:JACKSON, KRYSTAL ALECIA (PHARMD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ALECIA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:ALECIA
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1022 PINEWOOD LAKE CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1402
Mailing Address - Country:US
Mailing Address - Phone:561-452-5050
Mailing Address - Fax:
Practice Address - Street 1:1022 PINEWOOD LAKE CT
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-1402
Practice Address - Country:US
Practice Address - Phone:561-452-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist